- Urinary Tract Infection in Women
- What Is It?
- Kidney Infection Symptoms
- Lower Urinary Tract Symptoms
- Recognizing a Kidney Infection
- Symptoms in Children and Elderly People
- When to Seek Medical Attention
- Urinary tract infection (UTI)
- Causes of UTIs
- Preventing UTIs
- What You Need to Know When Headache and Back Pain Happen Together
- Symptoms of Kidney Failure
- See your doctor
- Urinary Tract Infection – Female
- Is this your child’s symptom?
- When to Call for Urinary Tract Infection – Female
- Seattle Children’s Urgent Care Locations
- Care Advice
- Pains you should never ignore
- 1. A sharp ache between your shoulder blades
- 2. A ‘thunderclap’ headache
- 3. Dull stomach pain to the lower right of abdomen
- 4. Tooth pain that wakes you up
- 5. Mid-back pain with fever
- 6. Menstrual cramps that don’t get better with medication
- 7. A tender spot on your calf
- Americans are taking too many pain meds: The risks you need to know about
- Pain You Should Never Ignore
Urinary Tract Infection in Women
What Is It?
Published: May, 2017
A urinary tract infection is an infection involving the organs that produce urine and carry it out of the body. These structures include the kidneys, ureters (long, slender tubes connecting the kidneys with the bladder), bladder and urethra. Doctors often divide urinary tract infections into two types, lower tract infections and upper tract infections:
- Lower tract infections — Infection of the bladder is called cystitis (bladder infection). Bacteria normally found in the intestine are the main cause of lower urinary tract infections. These bacteria spread from the anus to the urethra and bladder, where they grow, invade the tissue and cause infection.
- Upper tract infections — These involve the ureters and kidneys. These infections are called pyelonephritis or kidney infections. Upper urinary tract infections usually occur because bacteria travel up from the bladder into the kidney. Sometimes, they occur when bacteria travel from other areas of the body through the bloodstream and settle in the kidney.
Women are affected much more often than men because women have short urethras that allow relatively easy passage of bacteria into the bladder. Sexual intercourse can cause bacteria to spread upward into the bladder. Also, the use of contraceptive diaphragms and spermicides may change the normal bacterial environment around the urethra and make infection more likely.
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Kidney Infection Symptoms
A kidney infection can cause a fever, chills, nausea, or pain in your low back, abdomen, or pelvic area.
Symptoms of a kidney infection may include painful or frequent urination, lower back pain, and fever and chills. Getty Images; Thinkstock; Alamy
Kidney infections usually develop when bacteria from a urinary tract infection (UTI) travel from your bladder through the tubes, known as ureters, that connect your bladder to your kidneys.
Normally, urine flows from your kidneys into your bladder and flushes out any bacteria that may be present, preventing any infection in your bladder from spreading to your kidneys. But sometimes this urine flow becomes disrupted or even briefly moves in the wrong direction. (1,2)
When your kidneys become infected, a number of symptoms can occur. Some of these symptoms occur around the area of the infection, while others affect your whole body.
You may also have symptoms of a lower urinary tract infection when you have a kidney infection. These symptoms often precede your kidney infection, since a UTI usually affects your urethra and bladder before it spreads to your kidneys. (3)
Ideally, you’ll notice the symptoms of a UTI before it affects your kidneys. In this case, you can receive treatment and probably avoid a kidney infection, since a kidney infection usually follows a UTI. (4)
But sometimes, you may not notice the symptoms of your UTI until it affects your kidneys, or you may have a kidney infection that didn’t originate in your lower urinary tract.
It’s important to recognize the signs of a kidney infection so that you can receive a diagnosis and treatment from a health professional. If left untreated, a kidney infection can cause serious complications.
Lower Urinary Tract Symptoms
Typically, a kidney infection develops after a UTI has already affected your urethra — the tube through which urine exits your body — and your bladder. This area is known as your lower urinary tract. (1)
If you recognize the earlier signs of a UTI, you can seek treatment and usually avoid a kidney infection. But it’s possible that your symptoms won’t be severe enough to get your attention until the infection has spread to your kidneys. (4)
Whether or not you’re also experiencing kidney-specific symptoms, it’s important to look out for signs of a UTI affecting your lower urinary tract:
Painful Urination Known as dysuria, pain during urination is usually caused by inflammation in the lining of your urethra.
In addition to UTIs, dysuria can be caused by a number of other conditions, including vaginal yeast infections, kidney stones, and sexually transmitted infections (STIs). (5)
Frequent Urination A UTI can cause frequent and intense urges to urinate, even when you’ve recently emptied your bladder. (4)
That’s because an inflamed bladder (known as cystitis) from your infection may be more sensitive to pressure from your urine, giving you the sensation that your bladder is full even when it’s not. (6)
Recognizing a Kidney Infection
When you have a UTI that spreads to your kidneys, you’ll probably have symptoms in your lower urinary tract first. But the following symptoms indicate that your kidneys may also be affected:
Fever and Chills A UTI that’s limited to your lower urinary tract usually doesn’t cause flu-like symptoms, but when it spreads to your kidneys, your body’s immune system tends to kick into higher gear.
Pain in Your Lower Back or Side Your kidneys are located on each side of your body in the lower part of your torso. A kidney infection can cause pain on one or both sides of your body, or more general pain in your lower back. (2,3)
Pain caused by a kidney infection can range from mild to severe.
Nausea and Vomiting These symptoms, like fever and chills, indicate an infection that’s more severe and advanced than a typical UTI.
Abdominal or Pelvic Pain An infection in your abdominal region, such as in your kidneys, can cause your abdominal muscles to contract, causing pain.
Your pelvic or groin area may also be painful due to muscle contraction.
Cloudy or Smelly Urine While it’s possible for an infection in your lower urinary tract to cause changes in your urine, if it’s noticeably cloudy or smells foul, that’s an indication your UTI may have progressed to your kidneys. (2,3)
Cloudy urine may indicate the presence of pus, a thick, white or yellow liquid that can form in areas of infection. (7)
Dark or Bloody Urine The presence of new or old blood in your urine, giving it a reddish or dark appearance, indicates that your infection is advanced enough to have caused swelling and irritation that leads to bleeding somewhere in your urinary tract. (2,3)
Symptoms in Children and Elderly People
While the typical range of symptoms for a kidney infection applies to most adults, older adults and young children may have different symptoms.
If you’re over age 65, you may experience none of the typical symptoms of a kidney infection summarized above. Instead, you may only experience problems with your thinking, such as:
- Difficulty speaking
Children under 2 years old with a kidney infection may only have a high fever. (1)
Caregivers of very old and very young individuals should know to seek help when these signs or symptoms occur.
When to Seek Medical Attention
If you experience any symptoms of a kidney infection or a UTI more generally, it’s important to see a health professional to have them evaluated right away.
This is true especially if certain symptoms seem to appear suddenly, indicating that your UTI is spreading or growing more severe.
A kidney infection that isn’t treated effectively can become chronic (long-lasting), potentially causing permanent damage to your kidneys that impairs their function.
An untreated kidney infection can also lead to dangerous complications in the short term, such as a blood infection (sepsis). Symptoms of sepsis include:
- Fever and chills
- Rapid breathing
- Elevated heart rate
- Skin rash
- Profound weakness or lethargy
- Confusion (1,2)
Urinary tract infection (UTI)
Causes of UTIs
UTIs occur when the urinary tract becomes infected, usually by bacteria. In most cases, bacteria from the gut enter the urinary tract through the urethra.
This may occur when wiping your bottom or having sex, for example, but often it’s not clear why it happens.
The following may increase your risk of getting a UTI:
- conditions that obstruct your urinary tract, such as kidney stones
- difficulty emptying your bladder fully
- using a contraceptive diaphragm or condoms coated in spermicide
- a weak immune system – from chemotherapy or HIV, for example
- a urinary catheter (a tube in your bladder used to drain urine)
- an enlarged prostate gland in men
Women may be more likely to get UTIs because their urethra is shorter than a man’s and is closer to their anus (back passage).
If you get UTIs frequently, there are some things you can try that may stop it coming back. However, it’s not clear how effective most of these measures are.
These measures include:
- avoiding perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed varieties, and have a shower rather than a bath
- going to the toilet as soon as you need to pee and always emptying your bladder fully
- staying well hydrated
- wiping your bottom from front to back when you go to the toilet
- emptying your bladder as soon as possible after having sex
- not using a contraceptive diaphragm or condoms with spermicidal lubricant on them – you may wish to use another method of contraception instead
- wearing underwear made from cotton, rather than synthetic material such as nylon, and avoiding tight jeans and trousers
Speak to your GP if these measures don’t work. They may suggest taking a long-term course of antibiotics or they may give you a prescription for antibiotics you can use as soon as you experience symptoms of a UTI.
There’s currently little evidence to suggest that drinking cranberry juice or using probiotics significantly reduces your chances of getting UTIs.
What You Need to Know When Headache and Back Pain Happen Together
The following conditions can possibly cause headache and back pain to occur together:
Sometimes injuries, such as those sustained in a car accident, fall, or while playing sports, can cause headache and back pain to occur together.
Poor posture can put strain on the muscles of your head, neck, and back. Maintaining poor posture over time can lead to the development of both headache and backache.
Premenstrual syndrome (PMS)
PMS refers to a group of physical and emotional symptoms that occur between the time of ovulation and when a period starts.
Headache and back or abdominal pain are common PMS symptoms. Other symptoms to look out for can include:
- swollen or tender breasts
Headaches and back pain are common causes of discomfort during pregnancy. Other possible causes of discomfort include:
- frequent urination
Various infections can cause headache and back or body aches to occur together. One common example you may be familiar with is the flu.
Two other conditions are meningitis and encephalitis. A viral or bacterial infection often causes them.
Meningitis is an inflammation of the tissues surrounding the brain and spinal cord. Encephalitis is inflammation of brain tissue.
Meningitis can begin with general flu-like symptoms and quickly progress to more severe symptoms, such as:
- severe headache
- stiff neck
- high fever
Encephalitis can include:
- neck stiffness or pain
- mild flu-like symptoms
Migraine is a condition involving intense, throbbing headaches. The pain typically occurs only on one side of the head.
There’s some evidence that migraine and lower back pain are associated with each other.
Arthritis is the inflammation of the joints, which can lead to pain and stiffness. It typically gets worse as you age.
If arthritis occurs in your neck or upper back, you may experience headaches in addition to back and neck pain.
Irritable bowel syndrome (IBS)
IBS is a gastrointestinal (GI) disorder that can cause symptoms like diarrhea, constipation, and cramps. It can also affect other areas of the body besides the GI tract, causing symptoms like headache and back pain.
Fibromyalgia is a group of symptoms that includes pain that can be felt all over the body, extreme fatigue, and sleeping problems. Other symptoms may include:
- tingling in the hands and feet
- problems with memory
Polycystic kidney disease (PKD)
PKD is an inherited condition where noncancerous cysts develop on or in the kidneys. This can cause headache and pain in the back or side.
Other symptoms to look out for include high blood pressure and blood in the urine.
A brain aneurysm occurs when the walls of an artery in the brain become weakened and begin to bulge. If the aneurysm ruptures, it can be life-threatening. Symptoms can include:
- a sudden severe headache
- neck stiffness or pain
- double vision
If you think you or someone else is having an aneurysm, call 911 or go to the nearest emergency room.
when to seek emergency care
In some cases, headache and back pain may be a sign of a more serious medical condition. Always seek emergency care if you experience any of these symptoms:
- headache or back pain accompanied by a fever
- pain that happens following an injury or an accident
- symptoms of meningitis, including severe headache, high fever, stiff neck, and nausea or vomiting
- back pain that leads to a loss of bladder or bowel control
Symptoms of Kidney Failure
The symptoms for acute and chronic kidney failure may be different and may resemble other conditions or medical problems. Each individual may experience symptoms differently. It is important to consult your physician for a diagnosis.
Acute Kidney Failure Symptoms
Symptoms of acute kidney failure often depend on the underlying condition. Symptoms may include:
- Hemorrhage (unusual bleeding)
- Weakness and fatigue
- Diarrhea or bloody diarrhea
- Poor appetite
- Severe vomiting
- Abdominal pain
- Back pain
- Muscle cramps
- No urine output or high urine output
- Pale skin
- Swelling of the tissues
- Eye inflammation
- An abdominal mass you can feel
Chronic Kidney Failure Symptoms
Symptoms of chronic kidney failure include:
- Poor appetite
- Bone pain and/or muscle cramps
- Itching and/or dry skin
- Easily fatigued
- Urine problems:
- High urine output or no urine output
- Recurrent urinary tract infections
- Urinary incontinence
- Pale skin
- Bad breath
- Trouble hearing
- An abdominal mass you can feel
- Tissue swelling
- Poor muscle tone
- Change in mental alertness
- Metallic taste in mouth
Diagnosing Kidney Failure
If you experience any of these symptoms, see your doctor for an expert diagnosis. We use a variety of diagnostic methods, including blood tests and an ultrasound, to confirm a diagnosis of kidney failure. Learn more about kidney failure diagnosis at Stanford.
See your doctor
See your doctor if you experience symptoms such as:
- increased abdominal size or persistent abdominal bloating
- abdominal or pelvic (lower tummy) pain
- feeling full after eating a small amount
- needing to urinate often or urgently
And these symptoms
- are a change from the normal for you;
- persist for more than 2 weeks;
- and there is no other explanation for you having these symptoms.
Ovarian Cancer Australia
10 most common causes of death from cancer in Australian women (Australian Institute of Health and Welfare, 2017)
Ovarian cancer statistics in Australia (Australian Government, Cancer Australia)
Gompel A, Burger H. A commentary on a recent update of the ovarian cancer risk attributable to menopausal hormone therapy. Climacteric. 2015 June;18(3):376–8.
Kotsopoulos J, Terry KL, Poole EM, Rosner B, Murphy MA, Hecht JL et al. Ovarian cancer risk factors by tumor dominance, a surrogate for cell of origin. Int J Cancer. 2013 Aug 1;133(3):730–9.
Faber M, Kjær SK, Dehlendorff C, Chang-Claude J, Andersen KK, Høgdall E et al. Cigarette smoking and risk of ovarian cancer: a pooled analysis of 21 case–control studies. Cancer Causes Control. 2013 May;24(5):989–1004.doi:10.1007/s10552-013-0174-4.
Bassuk SS, Manson JE, Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. .Ann Epidemiol. 2015 Mar;25(3):193-200
Last updated 10 December 2019 — Last reviewed 28 June 2019
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at June 2019.
Urinary Tract Infection – Female
Is this your child’s symptom?
- Your child was diagnosed with a urinary tract infection (UTI)
- The most common UTI is a bacterial infection of the bladder. The medical name is cystitis.
- Your child is taking an antibiotic for the UTI
- You are worried that the fever or pain is not getting better fast enough
Symptoms of UTI
- Pain, burning or stinging when passing urine
- Suspect pain if a young child starts to cry while passing urine
- The feeling of “can’t wait” to pass urine may occur. This is called urgency.
- Passing small amounts of urine at a time often. This is called frequency.
- New onset of day or night -time wetting
- Pain in the lower tummy may also occur. If the kidney is infected, the pain is in the flank. The flank is the side right below the ribs.
- UTIs are a common cause of fevers without other symptoms in young children.
- The urine may be cloudy and have a bad odor. Sometimes, there is some blood in the urine.
Causes of UTI
- UTIs are caused by bacteria that travel up the urethra into the bladder. The opening of the urethra is just above the vagina.
- The vulva is the area outside the vagina. Soaps can cause this area to be red, sore and itchy. This can lead to UTIs. Stool that gets on the vulva is another big factor. This can happen with careless wiping. It can also happen with constipation.
- A rare cause is if the bladder isn’t emptied all the way. Reason: Urine that stays in the bladder too long can become infected.
- Cystitis is more common in girls than boys. This is due to the much shorter length of the urethra in girls.
Diagnosis of UTI
- A clean catch urine sample needs to be tested. A UTI is confirmed by finding white blood cells in the urine. A positive culture for bacteria is also needed.
When to Call for Urinary Tract Infection – Female
Call 911 Now
- Not moving or too weak to stand
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Side (flank) or lower back pain and new onset since starting antibiotic
- Stomach, side or back pain and worse since starting antibiotic
- Vomited 2 or more times and interferes with taking antibiotic
- Fever over 104° F (40° C)
- Shaking chills
- Age less than 1 year and any symptoms worse
- Taking antibiotic more than 24 hours and you think your child is worse
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
- Blood in urine and new onset since starting antibiotic
- Taking antibiotic more than 24 hours, and pain with passing urine is severe. (Plus the pain is not better 2 hours after taking pain medicine)
- Taking antibiotic more than 48 hours and fever still there or comes back
- Taking antibiotic more than 3 days and pain not better
- You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
- You have other questions or concerns
Self Care at Home
- Bladder infection on antibiotic with no other problems
- Questions about prevention of bladder infections
Seattle Children’s Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
Treatment for a Bladder Infection
- What You Should Know about Bladder Infections:
- Bladder infections are common in girls.
- Most infections do not respond to the first dose of an antibiotic.
- Often the bladder symptoms do not improve the first day.
- Here is some care advice that should help.
- Keep Giving the Antibiotic by Mouth:
- UTIs need a prescription antibiotic. It will kill the bacteria that are causing the bladder infection.
- Give it as directed.
- Try not to forget any of the doses.
- Give the antibiotic until it is gone. Reason: To keep the bladder infection from flaring up again.
- Pain Medicine:
- For pain when passing urine, give a pain medicine.
- You can use an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
- Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: Fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
- Give More Fluids:
- Give extra fluids to drink. Cranberry juice may be helpful.
- Reason: Fluids dilute the urine so that it does not sting.
- Baking Soda Baths – For Young Girls:
- Soak for 10 minutes to remove germs and to help with healing.
- Add 2 ounces (60 mL) baking soda per tub of warm water.
- Reason: Baking soda is better than vinegar for young girls.
- During soaks, be sure she spreads her legs. This allows the water to cleanse the genitals.
- Repeat baking soda soaks 2 times per day for 2 days.
- Vinegar Warm Water Soaks – For Older Girls After Puberty:
- Soak the genital area for 10 minutes to remove irritants and decrease pain.
- Add 2 ounces (60 mL) vinegar per tub of warm water. Reason: After puberty, vinegar water matches the normal acid level of the vagina.
- During soaks, be sure she spreads her legs. This allows the water to clean the genital area.
- Repeat vinegar water soaks once per day until is better.
- Young Girls – Avoid Soaps:
- Avoid bubble bath, soap, and shampoo to the vulva. Reason: They are irritants and can lead to a UTI.
- Only use warm water to clean the vulva area.
- What to Expect:
- Fever is usually gone in 48 hours.
- Pain and burning are often much better in 48 hours.
- Frequency (passing small amounts of urine often) is also usually better in 48 hours.
- Bladder infections occur more than once in 10% of girls.
- For any future fever without other symptoms, call your doctor’s office. Your child should be seen for a urine check.
- Return to School:
- Bladder infections cannot be spread to others.
- Your child does not need to miss any school or child care.
- Call Your Doctor If:
- Pain when passing urine becomes severe
- Fever lasts over 48 hours after starting the antibiotic
- Vomiting and can’t keep down the antibiotic
- You think your child needs to be seen
- Your child becomes worse
Prevention of Bladder Infections in Girls
- Tips for How to Prevent UTIs in Girls:
- When your child bathes, clean the genital area with warm water. Soap is not needed for young girls.
- Don’t use bubble bath, shampoo or other soaps in the bath water. Reason: They are irritants.
- Keep bath time less than 10 minutes. Your child also should pass urine right after baths.
- Teach your daughter to wipe herself correctly from front to back after a stool.
- Drink enough fluids each day to keep the urine light-colored.
- Pass urine at least every 4 hours during the day and avoid “holding back.”
- Wear cotton panties. Reason: To allow the skin to breathe. Your child doesn’t need to wear panties during the night.
- Avoid constipation.
- Call Your Doctor If:
- You have other questions or concerns
And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 02/01/2020
Last Revised: 03/14/2019
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
Pyelonephritis is a serious bacterial infection of the kidney that can be acute or chronic.
One of the most common renal diseases, acute pyelonephritis is a sudden inflammation caused by bacteria. It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules.
Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys and may lead to chronic renal failure. This disease is most common in patients who are predisposed to recurrent acute pyelonephritis, such as those with urinary obstructions or vesicoureteral reflux.
Doctors believe that the bacterial infection causing pyelonephritis may sometimes develop elsewhere in the body and travel through the bloodstream to the kidney. Far more commonly, however, the infection is the result of bacteria from outside the body traveling back up the urinary stream through the urethra to the bladder and eventually to the kidneys, in which case it is known as an ascending infection. This may explain why women, whose urethras are short and in close proximity to the anus, a potential source of bacteria, have four times as many cases of pyelonephritis as men.
The flow of urine backward is known as reflux and may be caused by an anatomical defect or by an obstruction. In the former case, instead of a tight valve between the bladder and the ureter, there is a wide opening. When the bladder contracts during urination, the urine goes both ways, out through the urethra and back up through the ureters. The defect is not easy to correct and those who have it are subject to repeat infections.
Obstructions that cause reflux in women are commonly in the form of a stricture, or scar tissue, itself formed from infection or inflammation in the urethra. In young men, such strictures form less often and usually are a consequence of a sexually transmitted infection. In older men, the prostate is commonly responsible for obstruction to the flow of urine.
Reflux can also be caused by the insertion of catheters or instruments such as cystoscopes for diagnosis or treatment. The introduction of any foreign body into an area of obstruction is fraught with danger of infection which can be more difficult to treat.
No matter what the underlying cause, the symptoms of acute bacterial pyelonephritis are often the same. The first indications are usually shaking chills, accompanied by a high fever and pain in the joints and muscles including flank pain. Attention may not be drawn to the kidneys at all.
The situation may be especially confusing in children, when high temperature may suddenly bring on a seizure or a change in mental state, or in the aged, where fever may bring confusion, or the infection may be masked by generalized aches and pains.
There may be irritative voiding symptoms (burning when urinating, a sense of urgency, or increased frequency of urination).
In acute infections, the symptoms develop rapidly, the fever noted first, followed by possible changes in the color of the urine, and then tenderness in the flank. As the kidney becomes more inflamed, pain, loss of appetite, headache, and all the general effects of infection develop. This type of kidney pain differs from renal colic pain of kidney stones in that it is continuous and does not come in waves, stays in one spot, and may be worse by moving around.
While patients with chronic pyelonephritis may have acute infections, sometimes there are no symptoms, or the symptoms may be so mild that they go unnoticed. This carries the risk that the infectious inflammatory disease may progress slowly undetected over many years until there is enough deterioration to produce kidney failure. Thus, hypertension (high blood pressure) or anemia or symptoms related to renal insufficiency may be the first indication of trouble. Unfortunately, irreversible damage may have already taken place.
Your physician will take a medical history, perform a physical exam, and recommend tests including blood tests and blood cultures, urinalysis and urine culture, and possibly an ultrasound study of the kidneys.
Treatment centers on antibiotic therapy appropriate to the specific infecting organism, after identification by urine culture. When the infecting organism cannot be identified, therapy usually consists of a broad-spectrum antibiotic. Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 21 days.
Patients with severe infections or complicating factors require hospitalization at least initially. In some patients, surgery may be necessary to relieve obstruction or correct an anatomical anomaly.
Follow-up treatment includes reculturing the urine several weeks after drug therapy stops in order to rule-out reinfection.
Patients at high risk of recurring urinary tract and kidney infections – such as those with prolonged use of an indwelling (Foley) catheter- require long-term follow-up.
What is the cause of the inflammation and infection?
Is there an anatomical defect or obstruction?
Can this defect be corrected?
Is the use of an antibiotic indicated?
What can be done to minimize further infection?
Would surgery be an option?
Is there any risk of eventual kidney failure?
Some cases of pyelonephritis can be prevented by prompt recognition and treatment of minor bladder infections that, if left untreated, may progress to this more severe condition.
Pains you should never ignore
May 7, 201403:51
1. A sharp ache between your shoulder blades
Could be: A heart attack
About 30 percent of people who have heart attacks don’t get the classic chest pressure. Pain between shoulder blades is common in women, as is jaw pain, shortness of breath and nausea. If you have these symptoms (you’ll likely have more than one), you need care ASAP.
A muscle pain is like a dull ache. A heart attack is more like a sharp sudden onset. Call 911. Do not drive yourself to the hospital. It’s better not to have someone drive you to the hospital. Wait for the ambulance because they are set up to do triage immediately.
2. A ‘thunderclap’ headache
Could be: An aneurysm, which is a balloon-like area in an artery
Most of us have experienced mild or moderate headaches — usually an over-the-counter pain medication makes the pain go away. But if you have the worst headache of your life and it comes on suddenly, call 911. Again, do not drive the hospital yourself.
How do you know it isn’t a migraine? With a migraine, you feel nauseous, are sensitive to light and sound and it’s a gradual progression.
Bleeding in the brain due to a ruptured aneurysm isn’t all that common, but when it does happen, swift action is key. Surgeons can save your life by sealing off the weakened spot. If you aren’t treated right away, you could die. The biggest risk is, if it does rupture, and you are bleeding into your brain, it becomes difficult to treat, if it can be treated at all.
Don’t take aspirin for such a sudden, intense headache — it can increase the bleeding.
3. Dull stomach pain to the lower right of abdomen
Could be: Appendicitis
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The pain usually starts at the center of your stomach and gradually moves to the right. If the appendix does rupture, that can be a dangerous complication, with bacteria bursting into your bloodstream and infecting your entire body. If you feel this sensation, go straight to the ER. (Usually, it gets more intense over a 24-hour period as it shifts location.)
Usually with appendicitis, when pressing down on your stomach it doesn’t hurt as much as when you let go quickly. Another test is where you use the muscle underlying the gall bladder: Bring your knee to your head and have someone push down with resistance. If that hurts, that’s a sign of an irritated appendix, which would need to be evaluated further.
4. Tooth pain that wakes you up
Could be: Teeth grinding
Frequent clenching can cause the nerve within the tooth to become inflamed and the protective enamel to wear away. You might even end up cracking teeth down to the root, which leads to extraction. Call your dentist so he or she can figure out the problem. The complications from grinding, which is often brought on by stress, can be prevented by wearing a night guard.
There are a lot of people who grind their teeth at night. At your annual checkup, your dentist can tell you if you need a night guard, for example, as an intervention.
5. Mid-back pain with fever
Could be: A kidney infection
Don’t assume that your temperature, nausea and back pain are just a stomach bug. This condition develops when bacteria that infiltrate the urinary tract spread to the kidneys, making the infection much more severe. You might start with urinary tract infection symptoms, like pain during urination, but some people don’t notice anything until later. You’ll likely need antibiotics ASAP, so call your doctor.
Women are more susceptible to getting UTIs, which is precursor to kidney infection. If a kidney infection is untreated, your kidneys can shut down. But it’s usually so painful, people don’t ignore it.
6. Menstrual cramps that don’t get better with medication
Could be: Endometriosis
If over-the-counter meds aren’t helping, this condition — in which the lining of the uterus grows somewhere else — might be to blame. Endometriosis impedes fertility, and it’s common. Forty percent to 60 percent of women whose periods are very painful may have it.
Unless you’re trying to conceive, your doctor can start you on oral contraceptives. If pain persists, you may need to have the tissue surgically removed.
7. A tender spot on your calf
Could be: Deep vein thrombosis (DVT)
If one small area of your leg is painful, you could have DVT, a blood clot in the deep veins. The spot may also be red and warm to the touch. DVT is more likely if you use birth control pills or recently took a long car or plane ride. Unless your leg is very swollen or the pain is getting worse rapidly, you can probably wait a day to see your doctor instead of going to the ER, but don’t delay any longer. The clot could increase in size or break off, move toward the lungs and stop blood flow.
It can go to your heart and give you a heart attack. It can go to your brain and give you a stroke.
As a preventive measure, if you’re on a long car ride or plane:
- get up every 1 to 2 hours and stretch or move around.
- write out the alphabet with your toes on the floor. Take your toes up and down, left to right. As you write the alphabet you squeeze the muscles, the veins, and pumping the blood back up, so it won’t clot.
- drink fluids and stay hydrated.
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Pain You Should Never Ignore
It’s wise to pay attention to pain. That throbbing in your knee could be telling you to go easy on the yard work, and that ache in your head might be your body’s plea for a nap or a tall glass of water. Some types of pain may even be a sign that you need to get to a hospital immediately.
“People have to make a judgment call for themselves, whether they’re going to go to an emergency room or make an appointment with their doctor,” says Robert Hockberger, MD, chair of emergency medicine at Harbor-UCLA Medical Center in Los Angeles. Paying close attention to pain can make that call easier to make. It could even save your life.
Of course, you shouldn’t worry about every ache and twinge. Hockberger offers some general rules of thumb to separate run-of-the-mill pain from the kind that could signal a serious medical problem.”We ask patients to rate their pain from a one to a 10,” he says. “People who feel that their pain is a seven or higher — anything worse than a bad toothache — should see a doctor right away.”
According to Hockberger, you should also see a doctor if you have moderate pain that doesn’t go away within a few days, or if any treatment that previously relieved pain suddenly stops working.
You’ll be way ahead in the guessing game if you familiarize yourself with some serious conditions that cause pain. This list is by no means definitive — a roster of every painful malady could fill a medical book, and probably has — but it’s a good place to start. If you’re alert to these problems, you’re likely to get the help you need.
Leg pain with swelling
Symptoms: One of your legs suddenly becomes painful and swollen. The pain is especially noticeable when you stand or walk around. The swollen area — most likely a calf or thigh — may be red or warm.
What it could be: Deep vein thrombosis, a clot forming in a vein deep within the leg. Such clots are dangerous because they can break free and move to the lungs, causing a pulmonary embolism. (In 2003, a pulmonary embolism killed 39-year-old NBC reporter David Bloom.) Deep vein thrombosis most often occurs when a person isn’t moving enough to keep blood flowing briskly through the legs. The condition is sometimes called “economy class syndrome,” because it can strike during a long plane ride. People stuck in hospital beds are also at risk, as are people over 60, women taking birth control pills, women who have recently given birth, and anyone who is overweight.
What you should do: Make an appointment to see a doctor immediately. Be sure to tell your doctor if you’ve just finished a long trip or if there is any other reason to suspect a blood clot. Prompt treatment can clear the clot before it has a chance to cause trouble.
Sudden testicular pain
Symptoms: As unpleasant as it may be, imagine a swift kick to the groin. The pain, possibly along with swelling, will be on one side of the scrotum. This isn’t just a dull ache. It’s the type of pain that makes it difficult to walk or even talk.
What it could be: Testicular torsion. In this condition, the cord that connects to the testicles becomes twisted, cutting off blood flow. Other possible (but rare) reasons include testicular cancer and epididymitis, an infection of a small organ on the testicle. However, infections of the testicle tend to come on much more gradually and aren’t nearly as painful.
What you should do: Get to a doctor immediately. If you do have testicular torsion, it’s an emergency, because the testicle will become damaged without adequate blood flow.
Symptoms: You feel pain or a burning sensation when urinating. You may also have frequent urges to urinate without results.
Condition: You probably have an annoying but harmless urinary tract infection (UTI), but in very rare cases painful urination could also be a sign of something serious, like a sexually transmitted disease or, much more rarely, bladder cancer. (The classic sign of bladder cancer is the painless passing of blood in the urine.) Although UTIs are especially common in women, men are three to four times more likely than women to get bladder cancer.
What you should do: Schedule an appointment with your doctor or urologist. If it’s nothing serious, treatment can quickly relieve the pain. If it is bladder cancer, prompt diagnosis can increase your chances of recovery.
Sudden chest pain
Symptoms: You suddenly feel unusual pain, discomfort, or pressure in the center of your chest. The feelings may linger for more than a few minutes, or they may disappear and come back. The pain and discomfort can spread to one or both arms or to the neck, jaw, stomach, or back. Other possible symptoms include shortness of breath, nausea, lightheadedness, or a cold sweat.
What it may be: You may have a pulmonary embolism (obstruction of a blood vessel by a clot or other matter), pneumothorax (too much air or gas in the chest cavity), or a bout of angina (chest pain caused by inadequate blood flow). You might also be having a heart attack.
Be aware that most heart attacks start much more slowly than the Hollywood variety — you’re more likely to feel a dull or vague pressure in the chest than a sharp pain. Some heart attacks are so subtle that it can be hard to tell then apart from simple indigestion or heartburn, Hockberger says. In many cases, it takes an EKG or other hospital test to tell the difference.
What you should do: If you think you might be having a heart attack or another medical emergency, don’t wait any longer than five minutes to call 911 or get to a hospital. If you really are having a heart attack or embolism, waiting too long to get help could be a fatal mistake.
The worst headache of your life
Symptoms: Picture your worst headache — even a skull-splitting migraine — and imagine turning it up several notches. This mega-headache can strike suddenly, “like a thunderclap,” Hockberger says. Other possible symptoms include double vision, nausea, vomiting, and a stiff neck.
What it may be: It could be just a bad migraine, but it could also be a ruptured aneurysm, bleeding in the brain that occurs when a weak spot in a blood vessel suddenly bursts. While migraines can cause similar symptoms, Hockberger notes that most people with migraines have their first episode before they turn 25. Doctors hear alarm bells when a person over 25 has the first killer headache of his or her life.
Every year, about 30,000 people in this country develop ruptured aneurysms. According to a report from Johns Hopkins Medical Institute, half of all ruptured aneurysms cause sudden death, but over 80 percent of patients who can make it to the hospital survive.
Anyone of any age can suffer a ruptured aneurysm, but they are more common in adults than in children. Smokers, people with hypertension, and people who abuse alcohol or illegal drugs are at especially high risk.
What you should do: Call 911 or get to an emergency room right away.
A stiff neck accompanied by fever and/or a severe headache
Symptoms: Many different things can cause sudden pain or stiffness in the neck. But if your neck trouble is accompanied by either a fever or a severe headache or both (often with sensitivity to light), you could be facing an emergency.
What it might be: You could be suffering from meningitis, an infection of the membrane that surrounds the brain. While meningitis can be caused by either viruses or bacteria, the bacterial kind is far more dangerous and potentially deadly. Bacterial meningitis comes on quickly — you may feel perfectly fine one day and deathly ill the next. The condition can also cause vomiting, nausea, and a rash along with behavioral changes such as confusion and sleepiness.
What you should do: Call 911 or get to an emergency room right away.
Sudden, sharp pain in the abdomen
Symptoms: You have pain that starts at the center of the abdomen, usually in the area around the belly button. It eventually becomes more severe and shifts to the lower right side of the belly, making it painful to the touch. You may also have nausea, vomiting, a low-grade fever (under 100 degrees) diarrhea, constipation, inability to pass gas, swelling in the abdomen, and a lack of appetite. Eventually, it may become so painful that it hurts to move. You may even feel like someone has put a knife or a bullet in your guts — from the inside.
What it may be: You may have appendicitis — inflammation of the appendix — a common emergency that’s easy to dismiss as “just another stomachache.” Ignoring the pain is dangerous, because an inflamed appendix could burst without prompt treatment.
The pain could also be a symptom of an inflamed gallbladder or pancreas. Just like an inflamed appendix, the gallbladder can rupture if it is not treated right away. An inflamed pancreas also needs prompt medical attention.
Finally, if you are female, you may have an inflamed ovarian cyst, a pelvic infection, or, if you’re of childbearing age, an ectopic pregnancy.
What you should do: If you think you may have appendicitis, an inflamed gallbladder, or an ectopic pregnancy, get to a hospital quickly. An ectopic pregnancy can be life-threatening, and if your appendix really is inflamed, it needs to be removed before it causes serious problems. Every year, about 260,000 people in the United States have surgery to remove a troublesome appendix. If you suspect you have a pelvic infection such as pelvic inflammatory disease, seek medical attention quickly — without treatment, this can cause permanent scarring, sterility, and in rare cases, a dangerous abscess.
Severe back pain
Symptoms: Back pain usually goes away on its own, with or without a doctor’s help. But if the pain is sudden, agonizing, and unrelated to exercise or improper lifting, OR if you feel excruciating, highly focused pain on your spine, you may be in the midst of an emergency.
What it may be: Sudden, severe back pain may signal a kidney stone or an abdominal aneurysm, a bulge in the main artery leading from the heart. Kidney stones blocking the flow of urine tend to cause sharp or cramping pain that starts in the back or side and moves to the groin. Abdominal aneurysms, most common in older people with atherosclerosis, may produce only mild pain as the bulge grows. The pain suddenly becomes excruciating if the aneurysm bursts.
Intense, pinpoint pain may be a sign of an infection beneath the membrane that covers the spinal cord. This condition, called an epidural abscess, strikes about 10,000 people each year. If not treated promptly, it can cause paralysis of the lower part of the body, sometimes in just a few hours. Epidural abscesses often come on the heels of minor infections, such as infections of the sinuses or urinary tract. People with diabetes and IV drug users are most at risk.
What you should do: Call 911 or get to an emergency room right away.
Nagging foot or shin pain
Symptoms: Your normally full exercise schedule is slowed down by persistent pain on the top of your foot or the front of your lower leg. The pain builds gradually, gets worse when you put weight on your leg, and fades when you rest. If the pain is on the top of your foot, you might also notice swelling on the sore spot.
What it could be: A stress fracture — a hairline crack in the bone. Stress fractures are common “overuse” injuries, often striking athletes in sports that give the feet a pounding, including track, basketball, and tennis. Adolescents and women with unusual or absent menstrual cycles are especially at risk.
What you should do: This isn’t a medical emergency, but it’s one time when you don’t want to play through the pain. Schedule an appointment with your doctor or orthopedist to get a diagnosis. If you have a stress fracture, you’ll need to take it easy for a couple of weeks to let your bone heal.
Pain is an imperfect guide to illness. Some conditions are painful but not dangerous, while other very serious conditions may strike with no pain at all. If you do have questions about a pain you have, it’s best to consult your doctor.
Interview with Robert Hockberger, MD, chair of emergency medicine at Harbor-UCLA Medical Center in Los Angeles
American Academy of Orthopaedic Surgeons. Stress fractures of the foot and ankle.
Cleveland Clinic. Appendicitis.
Galejs, L.E. and E.J. Kass. Diganosis and treatment of the acute scrotum. American Family Physician 59(4)
American Heart Association. Aortic aneurysm. http://www.americanheart.org/presenter.jhtml?identifier=4455
Stanford University. Information about bladder cancer. http://cancer.stanford.edu/urologic/bladder/
eMedicine. Aneurysm, Abdominal. http://www.emedicine.com/emerg/topic27.htm
Old, J.L. et al. Imaging for suspected appendicitis. American Family Physician. Vol. 71 (1) http://www.aafp.org/afp/20050101/71.html